Membership Renewal Form

June 24, 2017

You Agree:
If I am accepted as a member of this independent local chapter of the Harley Owners Group, I hereby agree to abide by the local chapter constitution. I have read the Annual Charter for H.O.G. Chapters and hereby agree to abide by it as a member of this dealer sponsored chapter. I recognize that while this Chapter is chartered with H.O.G., it remains a separate, independent entity solely responsible for its actions.

- THIS IS A RELEASE, READ BEFORE SIGNING -
I agree that the Sponsoring Dealer, Harley Owners Group (H.O.G.), Harley Davidson, Inc., Harley Davidson Motor Company, my Chapter and their respective officers, directors, employees and agents (hereinafter, the
“RELEASED PARTIES”) shall not be liable or responsible for injury to me (including paralysis or death) or damage to my property occurring during any H.O.G. or H.O.G. chapter activities and resulting from acts or omissions occurring during the performance of the duties of the Released Parties, even where the damage or injury is caused by negligence (except wilful neglect). I understand and agree that all H.O.G. members and
their guests participate voluntarily and at their own risk in all H.O.G. activities and I assume all risks of injury and damage arising out of the conduct of such activities.

I release and hold the “RELEASED PARTIES” harmless from any injury or loss to my person or property which may
result from my participation in H.O.G. activities and EVENT(S). I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE THE “RELEASED PARTIES” FOR ANY INJURY OR RESULTING DAMAGE TO MYSELF OR MY PROPERTY ARISING FROM, OR IN CONNECTION WITH, THE PERFORMANCE OF THEIR CHAPTER DUTIES IN SPONSORING,
PLANNING OR CONDUCTING SAID EVENT(S).

By signing this Release, I certify that I have read this Release and fully understand it and that I am not
relying on any statements or representations made by the “RELEASED PARTIES”

Your Contact Details

Address
Street Address - Line 1
Street Address - Line 2
City
State/Province
Zip/Postal
Country
* This will be used to keep you updated on club rides and other events.
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Your HOG International Details

* Delete the "AU" prefix if you hold an Int. HOG membership with a different country outside of Australia

Payment Details

AUD$
* If paying by Direct Deposit or EFT, please use your Int. HOG number as the transaction reference.
Online Payment Details
Card Number
Exp Month
Exp Year
Security Number

You Agree